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   Table of Contents - Current issue
Coverpage
September-December 2018
Volume 7 | Issue 3
Page Nos. 143-188

Online since Wednesday, February 6, 2019

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REVIEW ARTICLE  

The effectiveness of robotic-assisted gait training on walking speed for stroke survivors: Meta-analysis p. 143
Faisal Y Asiri
DOI:10.4103/sjhs.sjhs_16_18  
Background: Most stroke survivors have walking difficulties after the event, so regaining the ability to walk again is the main goal of rehabilitation intervention. The robotic-assisted device is widely used in rehabilitation settings and may have an advantage over conventional physical therapy in regaining walking capacity. Objectives: The objectives of this study were to investigate whether the robotic-assisted gait training (RAGT) alone improves walking capacity (e.g., gait velocity) compared with conventional gait training (e.g., over-ground gait training) in stroke survivors. Methods: An electronic Medline database (e.g., PubMed, Ovid, ISI of knowledge) search was done to identify trials. The searching process was limited to randomized clinical trials and recent studies from 2000 to 2017. All trials that did not use conventional physical therapy as a control group and did not use RAGT as an intervention were excluded from the study. Results: A total of 4 studies met our inclusion criteria, and they were included in the meta-analysis with 182 participants. Convention physical therapy training did significantly better than robotic-assisted training P = 0.003. Therefore, the conventional physical therapy group regained 30% (confidence interval 19%–41%) more in gait velocity than the robotic-assisted gait group. Conclusion: That robotic-assisted training alone did not show any improvement in gait velocity compared with regular physical therapy training. However, further research may address the use of robotic-assisted devices plus conventional physical therapy to compare the combined benefits with those of conventional physical therapy alone.
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ORIGINAL ARTICLES Top

Prevalence and risk factors of iron-deficiency anemia in Saudi female medical students p. 148
Mona Hmoud AlSheikh
DOI:10.4103/sjhs.sjhs_79_18  
Introduction: Iron-deficiency anemia (IDA) is quite common in female adolescents and adults worldwide. Despite the higher prevalence of IDA, there is a paucity of research in finding its prevalence and potential causes in young Saudi female population. Thus, the aim of this study was to determine the prevalence and possible causes of IDA in young female medical students and search for risk factors in the studied group. Materials and Methods: One hundred and twenty female students from Imam Abdulrahman Bin Faisal University were selected by randomized sampling whose blood samples were taken to measure their hemoglobin (Hb) and serum ferritin levels. According to the World Health Organization criteria, individuals with Hb <12 g/dL and ferritin <15 ng/mL were considered anemic. The sociodemographic, gynecological, and dietary data were collected from all the respondents with the help of a well-designed 15 items questionnaire. The association between IDA and the potential risk factors was found through Fishers' exact test or Chi-square test. Results: Among the studied group, 38.3% of total population were anemic. Mean Hb ± standard deviation (SD) was found to be 12.6 ± 1.3 and mean ferritin ± SD was 18.9 ± 5.2. No statistically significant correlation (P > 0.05) was found between IDA and the background, gynecological history, and dietary habits of the anemic participants. Conclusions: The higher prevalence rate of anemia among Saudi female medical students (38.3%) was similar to the earlier reports of the Gulf region. Considering the higher ratio of anemic students, iron supplements should be prescribed to the affected youngsters to improve their Hb level.
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Self-directed learning readiness and learning styles among Taibah nursing students p. 153
Khalid Abdullah Aljohani, Doaa El Sayed Fadila
DOI:10.4103/sjhs.sjhs_67_18  
Background: Advancements in nursing education programs stimulate the modifications in teaching and learning approaches to enhance nursing students' capabilities. Assessing students' learning styles and readiness to learn are essential components to guide such changes. Aim: This study aims to determine the nursing students' readiness for self-directed learning (SDL) and their learning styles. Methods: A cross-sectional descriptive, analytical research design was utilized in the present study. Two-hundred and thirteen nursing students studying two programs (regular and bridging) responded to the study instruments: demographics, SDL readiness (SDLR), and student-recorded responses to an online visual, aural/auditory, read/write, and kinesthetic (VARK) survey. Statistical analysis was performed using SPSS (version 20) to identify the descriptive and bivariate outcomes. Results: The response rate was 76%. Learning style results showed that aural, read-write, visual, and kinesthetic learning styles accounted for 19.7%, 8.5%, 6.6%, and 25.8% of participants, respectively. Desire for learning subscales were statistically significant for gender (t = 1.985, P = 0.048), academic level (F = 2.969, P = 0.033), and mode (t = 3.610, P = 0.001). The overall SDLR scale scores were significant for residence (t = 4.938, P = 0.001) and learning style (F = 5.197, P = 0.002). Conclusion: The study revealed that participants prefer to learn using unimodal VARK modalities, and the dominant learning style was kinesthetic. The participants' level of readiness for SDL and their self-control were high compared to the other SDLR subscales. The results showed a significant connection between the participants' learning styles and the variables of their readiness for SDL.
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Single-port video-assisted thoracoscopic surgery for the diagnosis of intrathoracic lesions p. 159
Majed Al-Mourgi, Mohamed Al Saeed, Bilal O Al-Jiffry, Tamer Abdel-Rahman, Samir Badr, Alaa Younes, Haneen Asaad, Mohamed Hatem
DOI:10.4103/sjhs.sjhs_115_18  
Background and Aim of Study: Diagnostic and therapeutic uniportal video-assisted thoracic surgery (VATS) is now considered a feasible and safe procedure with good results. In this retrospective chart review study, I will present our experience in diagnostic VATS at King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia. Materials and Methods: The data of 108 patients undergoing uniportal diagnostic VATS in King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia, from January 2013 to June 2015, were collected through a review of their hospital records. Results: The study included 108 patients (75 males and 33 females) with a mean age of 36.4 ± 8.1 years. The mean operative time was 28.5 ± 6.7 min. The most common morbidity was intraoperative bleeding that occurred in 15 cases (13.9%) and was easily controlled. Failure of VATS occurred in three cases (2.8%) due to massive adhesions, necessitating minithoracotomy. Reinsertion of the intercostal tube was required in 12 cases (11.1%). The mean duration to removal of the intercostal tube was 4.4 ± 0.9 days. The mean hospital stay was 6.4 ± 1.4 days. No operative or early postoperative mortality was recorded. Conclusion: Uniportal VATS is a safe and effective method for the diagnosis of intrathoracic lesions allowing resection of small localized lesions. It has a limited operative time that is improving with progress in the learning curve.
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Appraisal of maternal outcome of twin gestation p. 163
Obinna Izuchukwu Oraekwe
DOI:10.4103/sjhs.sjhs_45_18  
Background: Twin gestation with its attendant complications has been on the rise worldwide. Its periodic evaluation is necessary to update the extent of its contribution to maternal morbidities. Objective: To determine the incidence and maternal antepartum, intrapartum, and postpartum complications associated with twin pregnancies. Materials and Methods: This was a retrospective study carried out in the Federal Medical Centre, Umuahia, Abia state, Nigeria, over a 5-year period from January 1, 2009, to December 31, 2013. During the period of study, there were 264 twin pregnancies, but only 186 folders had enough information for data analysis. Data were analyzed using WinPepi version 11.65. Statistical significance was calculated using Chi-square test with level of significance set at P < 0.05. Results: The incidence of twin pregnancy was 3.2% (32/1000 deliveries). The mean age was 29.5 ± 5 years. Most of the patients (35.5%) were aged between 25 and 29 years. Most of the patients (64.5%) were booked. Preterm delivery accounted for 30.6% of antenatal complications, while hypertensive disorders of pregnancy made up 14.5%. Majority of the patients (54.3%) had cesarean delivery, and the most common indication for cesarean delivery was malpresentation of the leading twin which accounted for 40.6% of the indications for cesarean deliveries. Anemia was the most common postpartum complication noted in 25.3% of patients and that was followed by primary postpartum hemorrhage with a rate of 10.8%. Conclusion: This study has highlighted the high incidence of twin pregnancy in our environment. It has also affirmed the significant maternal morbidities associated with this obstetric condition.
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Serological screening of hepatitis B virus and hepatitis C virus among patients attending a tertiary hospital in Jalingo, Taraba state, Nigeria p. 167
Victor Omote, Emmanuel Kashibu, Isreal Ojumah, Danjuma Adda, Johnson Etaghene, Henry Ukwamedua
DOI:10.4103/sjhs.sjhs_39_18  
Background: The rising prevalence of hepatitis B and hepatitis C viral infection as single or co-infection among the Nigerian populace and their association with hepatocellular carcinoma is a serious health issue. Aims and Objective: The aim of this study is to determine the prevalence of hepatitis B and C among patients seen in a tertiary health facility in Jalingo. Settings and Design: This is a cross-sectional and prospective study carried out among patients at a tertiary health-care facility in Jalingo, Taraba state of Nigeria. Materials and Methods: A total of 513 patients were screened for both hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (HCV) using rapid chromatographic immunoassays for their qualitative detection in plasma. Result: Of the 513 patients screened, 70 (13.60%), 85 (16.6%), and 5 (1.0%) were positive of HBsAg, anti-HCV, and co-infection, respectively. About 14.7% and 20.1% were the highest gender-based prevalence recorded for HBsAg and anti-HCV, respectively, and they were recorded for the male gender. Age group 21–40 years had the highest prevalence rate of 19.2% for HBsAg, whereas age-group 61 years and above had a high prevalence of 31.3%. Conclusion: The high prevalence rates obtained from this study for both viral hepatitis calls for augmentation of existing interventions toward the prevention, diagnosis, and treatment of these diseases. Further studies aimed at evaluating the efficacy of the interventions are highly recommended.
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Prevalence and risk factors of low back pain among Taif surgeons p. 172
Turki Hamdan Alzidani, Abdullah Mohammed Alturkistani, Basel Saad Alzahrani, Arwa Muneer Aljuhani, Khalid Mohammed Alzahrani
DOI:10.4103/sjhs.sjhs_70_18  
Background: Low back pain (LBP) is one of the most common complaints, especially among healthcare workers, with great impact on daily lifestyle and job performance regarding disability and absence. Therefore, in this study, we aimed to assess the prevalence and associated risk factors of LBP among surgeons of different specialties in Taif city, Saudi Arabia. Methods: A cross-sectional study among surgeons in Taif city randomly selected from the three major hospitals in the city, using a self-administered questionnaire of 41 items divided into three parts including demographic data, individual and occupational characteristics, and prevalence data. Results: The prevalence data of LBP were point prevalence of 28 (20.3%), last month prevalence of 67 (48.6%), last year prevalence of 91 (65.9%), and lifetime prevalence of 101 (73.2%). Some of the investigated individual and occupational characteristics associated with the prevalence of LBP with a statistically significant (P < 0.05) such as smoking, specialty, overall standing time, perceived level of stress, and using preventive strategies. Others might be associated but with no statistically significant (P > 0.05) such as age, gender, body mass index, and job satisfaction. Rest and painkillers are the best option for most of the affected surgeons to relieve the pain. Conclusion: LBP has a high prevalence in the healthcare field, and the results of this study show high prevalence among surgeons, with many avoidable risk factors. Recommendations: More studies must be conducted and planning educational programs and campaigns to reduce the magnitude of this problem.
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Povidone-iodine and glycerine for treatment of acute otitis externa p. 178
Monika Patel, Arun Dehadaray
DOI:10.4103/sjhs.sjhs_68_18  
Introduction: Acute otitis externa (AOE) is the inflammation of the external ear. It usually presents with severe pain in the ear. The treatment of AOE should aim in relieving pain at the earliest. Out of the various treatment options, topical treatment should be considered as prescribing oral antibiotics without local treatment can cause antibiotic abuse. Due to unavailability, cost, and compliance issues of other topical measures, we observed and proved the effectiveness of a new modality glycerine and povidone-iodine wick in the treatment of AOE. Objectives: The objective of this study is to study the efficacy of new modality treatment-glycerine and povidone-iodine wick for AOE. Materials and Methods: Three hundred and forty-seven cases with AOE due to exclusive bacterial infection were included in the study. Otitis externa was graded as per Brighton grading scheme. Pain score was assessed using Wong and Baker pain assessment scale. Patients were treated by performing a thorough aural toilet, keeping a glycerine and povidone iodine wick in the EAC and prescribing a nonsteroidal anti-inflammatory drug. Few severe cases were administered the systemic antibiotic. Score of pain, canal edema, and the presence of ear fullness on D1, D3 (48 h later), and D5 was noted. Further assessment and repacking with a fresh wick was done if required until the pain and edema subsides completely. Results: It was seen that canal edema and tragal tenderness subsided significantly (P < 0.001) on follow-up visits. The severity of pain scale on D1 decreased significantly (P ≤ 0.001) on D3. On D3 or the first follow-up visit, 68 (19.5%) of patients required repacking, whereas there was no need for repacking on D5, i.e., second follow-up visit. Average duration of the clinical resolution was 3 days. Conclusions: The treatment method was readily available, easy to perform, cost-effective and had a better patient compliance. Povidone-iodine scores with no proven microbial resistance until date. To enhance delivery of drug locally specialist ear cleaning followed by wick insertion should be done. Use of glycerine and povidone-iodine ear pack is definitely effective with the good clinical outcome by 3 days maximum duration is 7 days. Use of oral antibiotics only for selected cases along with topical treatment for otitis externa is advisable. The outcome regarding pain relief and edema reduction were analyzed with satisfactory outcome at the earliest.
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CASE REPORTS Top

Ovarian penetration by copper intrauterine device: A rare phenomenon p. 183
Muhammad Baffah Aminu, Lamaran Makama Dattijo, Muhammad Shittu Adamu
DOI:10.4103/sjhs.sjhs_62_18  
The insertion of a piece of object inside the uterus has been practiced as a form of birth control since antiquity; one of these devices used nowadays is the intrauterine contraceptive devices which have gained a wide range of acceptance because of their safety, efficacy, and cost-effectiveness. There have been cases of migration of intrauterine devices (IUDs) to adjacent peritoneal structures, but ovarian migration has not been widely reported in West Africa. This case report highlights one of the rare complications of IUD migrating to the left ovary of a 24-year-old woman with no complication. It is imperative that insertion should be done timely by well-trained personnel to avoid the incidence of complications.
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Survival in esophageal atresia diagnosed on 19th day of life: Lessons learned p. 186
Rahul Gupta, Dinesh Kumar Barolia, Neelam Dogra, Aditya Pratap Singh, Ramesh Tanger, Arun Kumar Gupta
DOI:10.4103/sjhs.sjhs_76_18  
Delayed diagnosis of esophageal atresia (EA) is associated with bad prognosis. Only five cases of survival with delayed presentation in the 3rd week of life have been previously reported. We present a rare case of survival in a neonate, who presented on the 19th day of life with regurgitation of feed and respiratory distress. After preoperative optimization, primary repair was performed the next day. The use of number 10 sterile, blunt-tipped, soft-red rubber catheter to rule out EA shortly after the birth in the delivery (resuscitation) room by attending doctor or trained paramedical personnel is recommended.
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